Provider Demographics
NPI:1871674879
Name:HUMANGOOD NEVADA
Entity Type:Organization
Organization Name:HUMANGOOD NEVADA
Other - Org Name:LAS VENTANAS RETIREMENT COMMUNITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REVENUE CYCLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATE
Authorized Official - Middle Name:
Authorized Official - Last Name:WINTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-924-7115
Mailing Address - Street 1:10401 W CHARLESTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-1151
Mailing Address - Country:US
Mailing Address - Phone:702-207-4201
Mailing Address - Fax:702-360-8643
Practice Address - Street 1:10401 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89135
Practice Address - Country:US
Practice Address - Phone:702-207-4201
Practice Address - Fax:702-360-8643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4529SNF-0314000000X
NV4529SNF-15314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV295086Medicare Oscar/Certification